March 16--Meet the Surgeon

I have an appointment to see the best surgeon for breast cancer, Dr. Nathalie Johnson. It's at her Good Samaritan office at 7:45 AM. Even though I am not a morning girl at all, I don't care--I'm on my way over there. I get there to discover they erred--she's at her St. Vincent's office! I jump in a taxi, and get there in about 15 minutes.

And yes, of course I baked her some cookies: Chewy Chocolate Chip and Oatmeal-Raisin with fresh grated nutmeg. She says she's never met a cookie she didn't like.

Dr. Johnson examines both of my breasts, listens to my heart and lungs, and reads the pages and pages of history she had me fill out. She explains her recommendations very clearly and with a minimum of jargon--she's good at this explaining stuff.

I love her.

She confirms what my gynecologist (Dr. Michelle Sang) told me on Friday--that the results from the pathology studies of the biopsy are all good. It's small (aka Stage I) and the estrogen and progesterone receptors are both +3, also a very good thing. My C-ERB (aka Her-2-Neu) is negative and the proliferation level is low. (I'm putting some of this technical stuff up here for my friends who understand what it is, but I'm not going to try to explain it.)

She recommends lumpectomy, which means she goes in and scoops out the tumor and a little of the normal tissue around it. I won't need reconstructive surgery or anything. She'll also biopsy some of my lymph nodes to see if the cancer has spread. She's confident it hasn't, but wants to check--I agree! They'll keep me overnight in the hospital and then I go home.

Radiation is the standard post-lumpectomy treatment. She thinks I'm a good candidate for a new kind of radiation therapy. The standard is to get what's kinda like an x-ray 5 days a week for 6-7 weeks, beginning about a month after surgery. The main side effects are fatigue, which grows over the treatment period, the risks from the radiation damaging heathy cells., a sense like sunburn, and sometime swelling.

A newer approach involves putting a balloon where the lump was removed (kind of like putting an arena where you tore out the slum housing?). The balloon is filled with saline and attached to a thin tube. Twice a day, radioactivity is added to the water through the tube, and then sucked out. This happens twice a days for 5 days, and then they remove the balloon. It's done on an outpatient basis, so I can hang out with the cat in between boob waterings. Dr. J tells me I'll be off work for 2 weeks with this approach. With standard therapy I'd go back to work sooner, but be tired for a longer period of time.

This newer option, of course, appeals to me more than the standard approach, but I want to see what the oncologist says tomorrow. How "experimental" is the new approach? Also, Dr. Siegal thinks that there are some really strong negatives for radiation at all, and that I should consider chemo. I'll see what Dr. Orwoll has to say.

Dr. Johnson also wants me to have a special scan called a Breast Specific Gamma Imaging (BSGI) of both breasts. This is better (and less hassle) than an MRI at catching any other little bits and bobs of cancer cells. I'm scheduled for 8 am Wednesday (why is all this cancer stuff so damned early in the morning?). She also wants me to get some blood tests, including a Vitamin D level. I'll do that Wednesday, too.

Then we get to the Big Question. I'm scheduled to leave on my cruise from Dubai to Istanbul, finishing with 5 days in Istanbul, on March 30. We don't have two weeks--do I have to (gasp, sob) cancel my vacation? She tells me to go on my cruise--the cancer is so non-agressive that there will be no damage by waiting until I get back at the end of April. Yay!

I'm now scheduled for my surgery on Tuesday, April 28. I had thought about April 27, and was so glad she doesn't operate on Mondays, because this means I can still go to Taste of the Nation on the 27th!

So my next steps: Tuesday I see the oncologist and my psychiatrist. Wednesday I get the BSGI scan and some blood work. Sometime this week I'll have a consult with a radiation oncologist at Good Sam (Dr. Lee?). Then I'll make my decisions about what post-surgical treatment I want, and put it all aside while I get ready for a Dirty Martini show on the 21st, while I desperately try to finish all the work I need to get done before I leave, and get ready to leave March 30. Whew!

More tomorrow after I see the oncologist.